Symptoms of Coronary Artery Disease

The most common symptom of coronary artery disease is angina (also called angina pectoris). Angina is often referred to as chest pain. It is also described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw.

If you have angina or any of the symptoms listed below that last for more than 5 minutes, SEEK EMERGENCY TREATMENT (CALL 9-1-1) WITHOUT DELAY. These symptoms could be the signs of a heart attack (also called myocardial infarction or MI) and immediate treatment is essential.

Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach

Difficulty breathing or shortness of breath

Sweating or “cold sweat”

Fullness, indigestion, or choking feeling (may feel like “heartburn”)

Nausea or vomiting

Light-headedness, dizziness, extreme weakness or anxiety

Rapid or irregular heart beats

Call 9-1-1 – Not a friend

Calling 9-1-1 is almost always the fastest way to get life-saving treatment. Due to the possible benefits of taking aspirin early on during a heart attack, emergency personnel may tell you to chew an aspirin if there is no medical reason for you to avoid aspirin. When they arrive, emergency personnel can promptly begin treatment, and they are trained to revive someone whose heart has stopped. Also, you’re likelier to get treated faster at the hospital if you arrive by ambulance. If you are having symptoms, do not drive yourself unless there is absolutely no other option.

If you have been prescribed nitroglycerin and you experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 9-1-1 to get emergency help. DO NOT DELAY. Due to the possible benefits of taking aspirin early on during a heart attack, emergency personnel may tell you to chew an aspirin if there is no medical reason for you to avoid aspirin. After calling 9-1-1, continue taking your nitroglycerin as prescribed.

Symptoms of coronary artery disease in women:

Studies show that women's symptoms are less likely identified as heart disease related. The symptoms of coronary artery disease and heart attack can be different for women than they are in men. Women are also less likely to recognize the symptoms of a heart attack and seek treatment. By learning and recognizing the symptoms, women can become assertive in their treatment. The most common symptoms of heart disease in women are:

On average, symptoms of heart disease appear 10 years later in women than men. Women tend to have heart attacks 10 years later than men do.

In addition, women often report their symptoms before having a heart attack, although the symptoms are not typical “heart” symptoms. In a multi-center study of 515 women who had an acute myocardial infarction (MI), the most frequently reported symptoms were unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. The majority of women (78%) reported at least one symptom for more than one month before their heart attack. Only 30% reported chest discomfort, which was described as an aching, tightness, pressure, sharpness, burning, fullness or tingling.

Types of Angina

Stable angina:

A type of angina brought on by an imbalance between the heart’s need for oxygen-rich blood and the amount available. It is "stable," which means the same activities bring it on; it feels the same way each time; and is relieved by rest and/or oral medications. Stable angina is a warning sign of heart disease and should be evaluated by a doctor. If the pattern of angina changes, it may progress to unstable angina.

Unstable angina:

This type of angina is considered an acute coronary syndrome. It may be a new symptom or a change from stable angina. The angina may occur more frequently, occur more easily at rest, feel more severe, or last longer. Although this angina can often be relieved with oral medications, it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required. Unstable angina is an acute coronary syndrome and should be treated as an emergency.

Variant angina (also called Prinzmetal's angina or coronary spasm):

A coronary artery can go into spasm, disrupting blood flow to the heart muscle (ischemia). It can occur in people without significant coronary artery disease. However, two thirds of people with variant angina have severe disease in at least one vessel, and the spasm occurs at the site of blockage. This type of angina is not common and almost always occurs when a person is at rest - during sleep. You are at increased risk for coronary spasm if you have: underlying coronary artery disease, smoke, or use stimulants or illicit drugs (such as cocaine). If a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur.

What’s the difference between angina and a heart attack?

Angina is a warning symptom of heart disease – but it is not a heart attack. The symptoms of a heart attack (also called myocardial infarction or “MI”) are similar to angina.

Angina

Heart Attack

Is brought on by a brief period of poor blood supply to the heart muscle

Occurs when the blood supply to the heart muscle is blocked for an extended period of time (often due to a clot forming in a partially blocked coronary artery)

Does not cause permanent damage to the heart

Results in permanent damage to the heart muscle

Symptoms last just a few minutes and are usually relieved by rest and/or medications. Symptoms include chest pain or discomfort, shortness of breath, palpitations, faster heart rate, dizziness, nausea, extreme weakness and sweating.

Symptoms usually last more than a few minutes and include chest pain or discomfort that lasts for more than a few minutes or goes away and comes back; pain or discomfort in other areas of the upper body; difficulty breathing or shortness of breath; sweating or “cold” sweat; fullness, indigestion or choking feeling; nausea or vomiting; light-headedness; extreme weakness; anxiety; rapid or irregular heartbeats

Symptoms are relieved by rest and/or medications within a few minutes

Symptoms are not relieved by rest or oral medications

Does not require emergency medical attention; however, it is important to call your doctor if this is the first time you’ve experienced angina, if you have new symptoms or if they become more frequent or severe

Know in advance

If you are at risk for a heart attack. Ask your doctor about your risk and what you should do to reduce your risk. Be sure to ask about aspirin and nitroglycerin.

Who to call for emergency help. Do not call a friend or family member. Call for an ambulance to take you to the nearest emergency room (Dial 9-1-1 in most areas).

Share this information with your family members and caregivers so they can recognize the symptoms of a heart attack and when to seek emergency treatment.

Remember

Learn to recognize your symptoms and the situations that cause them.

Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

If angina occurs:

What is Nitroglycerin?

Nitroglycerin is the most common vasodilator used for acute cases of angina. It works to dilate or widen the coronary arteries, increasing blood flow to the heart muscle and to relax the veins, lessening the amount of blood that returns to the heart from the body.

This combination of effects decreases the amount of work for the heart. Nitroglycerin comes in tablet or spray form. If you have angina, it is important that you keep this medication with you at all times.

Nitroglycerin must be kept in a dark container.

Keep it away from heat or moisture.

Check the expiration date on the container.

Once the container is opened, it must be replaced every 6 months

If you have been prescribed nitroglycerin and experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 911 to get emergency help.

For patients diagnosed with chronic stable angina: If you experience angina, take one nitroglycerin tablet and let it dissolve under your tongue, repeating every 5 minutes for up to 3 tablets spanning 15 minutes. If you still have angina after taking 3 doses of nitroglycerin, call 911 to get emergency help.

[Reference: ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Journal of the American College of Cardiology, 2007. 50(7):1-157.]

Use of Aspirin with unstable chest pain: After you call 9-1-1, if you do not have a history of aspirin allergy or bleeding, emergency personnel may advise that you chew one full (325 mg) aspirin slowly. It's especially effective if taken within 30 minutes of the onset of symptoms.

Do not drive yourself to the hospital. In many cases, the emergency personnel can begin to give you heart-saving care right away.

To prevent damage to your heart muscle, do not delay seeking medical treatment.